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Girón-Callejas A, García-Morales C, Mendizabal-Burastero R, Meza RI, Sierra T, Tapia-Trejo D, Pérez-García M, Quiroz-Morales VS, Paredes M, Rodríguez A, Juárez SI, Farach N, Videa G, Lara B, Rodríguez E, Ardón E, Sajquim E, Lorenzana R, Ravasi G, Northbrook S, Reyes-Terán G, Ávila-Ríos S. High level of pre-treatment and acquired HIV drug resistance in Honduras: a nationally representative survey, 2016-17. J Antimicrob Chemother 2021; 75:1932-1942. [PMID: 32303063 DOI: 10.1093/jac/dkaa100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/11/2020] [Accepted: 02/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pre-treatment HIV drug resistance (HIVDR) to NNRTIs has consistently increased in low-/middle-income countries during the last decade. OBJECTIVES To estimate the prevalence of pre-treatment HIVDR and acquired HIVDR among persons living with HIV (PLHIV) on ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48) in Honduras. PATIENTS AND METHODS A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from October 2016 to November 2017. Twenty-two of 54 total ART clinics representing >90% of the national cohort of adults on ART were included. HIVDR was assessed for protease and reverse transcriptase Sanger sequences using the Stanford HIVdb tool. RESULTS A total of 729 PLHIV were enrolled; 26.3% (95% CI 20.1%-33.5%) ART initiators reported prior exposure to antiretrovirals. Pre-treatment HIVDR prevalence was 26.9% (95% CI 20.2%-34.9%) to any antiretroviral and 25.9% (19.2%-33.9%) to NNRTIs. NNRTI pre-treatment HIVDR was higher in ART initiators with prior exposure to antiretrovirals (P = 0.001). Viral load (VL) suppression rate was 89.7% (85.1%-93.0%) in ADR12 and 67.9% (61.7%-73.6%) in ADR48. ADR12 to any drug among PLHIV with VL ≥1000 copies/mL was 86.1% (48.9%-97.6%); 67.1% (37.4%-87.5%) had HIVDR to both NNRTIs and NRTIs, and 3.8% (0.5%-25.2%) to PIs. ADR48 was 92.0% (86.8%-95.3%) to any drug; 78.1% (66.6%-86.5%) to both NNRTIs and NRTIs, and 7.3% (1.8%-25.1%) to PIs. CONCLUSIONS The high prevalence of NNRTI pre-treatment HIVDR observed in Honduras warrants consideration of non-NNRTI-based first-line regimens for ART initiation. Programmatic improvements in HIVDR monitoring and adherence support may also be considered.
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Affiliation(s)
| | - Claudia García-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | | | - Rita I Meza
- Secretaría de Salud de Honduras, Tegucigalpa City, Honduras
| | - Tomasa Sierra
- Secretaría de Salud de Honduras, Tegucigalpa City, Honduras
| | - Daniela Tapia-Trejo
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Marissa Pérez-García
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Verónica S Quiroz-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Mayte Paredes
- Universidad del Valle de Guatemala, Tegucigalpa City, Honduras
| | | | - Sandra I Juárez
- US Centers for Disease Control and Prevention, Central American Region, Guatemala City, Guatemala
| | - Nasim Farach
- US Centers for Disease Control and Prevention, Central American Region, Guatemala City, Guatemala
| | | | - Bredy Lara
- Secretaría de Salud de Honduras, Tegucigalpa City, Honduras
| | | | - Elvia Ardón
- Secretaría de Salud de Honduras, Tegucigalpa City, Honduras
| | - Edgar Sajquim
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | - Sanny Northbrook
- US Centers for Disease Control and Prevention, Central American Region, Guatemala City, Guatemala
| | - Gustavo Reyes-Terán
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
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Bertagnolio S, Beanland RL, Jordan MR, Doherty M, Hirnschall G. The World Health Organization's Response to Emerging Human Immunodeficiency Virus Drug Resistance and a Call for Global Action. J Infect Dis 2017; 216:S801-S804. [PMID: 29040686 PMCID: PMC5853942 DOI: 10.1093/infdis/jix402] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The global community, including the World Health Organization (WHO), has committed to ending the AIDS epidemic and to ensuring that 90% of people living with human immunodeficiency virus (HIV) are diagnosed, 90% start treatment, and 90% achieve and maintain virological suppression. The emergence of HIV drug resistance (HIVDR) as antiretroviral treatment programs expand could preclude the 90-90-90 targets adopted by the United Nations General Assembly at the High-Level Meeting on Ending AIDS from being achieved. The Global Action Plan on HIVDR is a call for collective action grounded on normative guidance providing a standardized and robust approach to monitoring, preventing, and responding to HIVDR over the next 5 years (2017-2021). WHO is committed to supporting country, global, regional, and national partners to implement and monitor the progress of the Global Action Plan. This article outlines the key components of WHO's strategy to tackle HIVDR and the role the organization takes in leading the global response to HIVDR.
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